Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy
Background: Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease, highlighting the importance of thorough cardiovascular screening in individuals with prior HDP. Objectives: This retrospective cohort study evaluated rates of cardiovascular screeni...
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Elsevier
2025-09-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005137 |
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| author | Madelyn Hurwitz, BA Asma Rayani, MBBS, ScM Jared A. Spitz, MD Andrew H. Nguyen, DO Ain Shajihan, MD Olayinka J. Agboola, MD, MPH Sharmaine McCoy, DNP, NP Lily N. Dastmalchi, DO Antonio F. Saad, MD, MBA Scott A. Sullivan, MD Yaa Adoma Kwapong, MD, MPH Roxanne Mirabal-Beltran, PhD, RN Faith E. Metlock, PhD, RN Garima Sharma, MD |
| author_facet | Madelyn Hurwitz, BA Asma Rayani, MBBS, ScM Jared A. Spitz, MD Andrew H. Nguyen, DO Ain Shajihan, MD Olayinka J. Agboola, MD, MPH Sharmaine McCoy, DNP, NP Lily N. Dastmalchi, DO Antonio F. Saad, MD, MBA Scott A. Sullivan, MD Yaa Adoma Kwapong, MD, MPH Roxanne Mirabal-Beltran, PhD, RN Faith E. Metlock, PhD, RN Garima Sharma, MD |
| author_sort | Madelyn Hurwitz, BA |
| collection | DOAJ |
| description | Background: Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease, highlighting the importance of thorough cardiovascular screening in individuals with prior HDP. Objectives: This retrospective cohort study evaluated rates of cardiovascular screening studies (lipid panel, lipoprotein(a), apolipoprotein B, hemoglobin A1c) ordered by cardiology in the first year postpartum before and after establishment of a postpartum cardiovascular care pathway within the Inova Health System. Methods: The study population included postpartum adults with recent pregnancies complicated by HDP seen by designated clinicians after care pathway establishment (7/1/23-3/31/24) in the cardio-obstetrics cohort (n = 113) or by cardiology before care pathway establishment (6/1/20-6/30/23) in the historical cohort (n = 179). Sociodemographic and clinical characteristics and rates of screening ordered were evaluated between cohorts. Results: There were no significant differences between cohorts in age, race/ethnicity, parity, prior history of HDP, or rates of pre-eclampsia. The mean age across both cohorts was 33 years. The cardio-obstetrics cohort had significantly higher rates of screening ordered compared to the historical cohort: lipid panel: 85.0% vs 33.0%, lipoprotein(a): 62.8% vs 6.2%, apolipoprotein B: 31.0% vs 1.1%, and hemoglobin A1c: 76.1% vs 18.4% (all P < 0.001). Evaluation of prepregnancy and postpregnancy cardiometabolic health parameters and electronic medical record-based social determinants of health and psychological health screening demonstrated elevated rates of risk factors across both cohorts. Conclusions: Implementation of a postpartum cardiovascular care pathway is feasible and is associated with significantly increased rates of cardiometabolic risk factor screening ordered in the first year postpartum. |
| format | Article |
| id | doaj-art-1f8832eed5eb4fa697447e9fd71c3c26 |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-1f8832eed5eb4fa697447e9fd71c3c262025-08-23T04:50:09ZengElsevierJACC: Advances2772-963X2025-09-014910208810.1016/j.jacadv.2025.102088Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of PregnancyMadelyn Hurwitz, BA0Asma Rayani, MBBS, ScM1Jared A. Spitz, MD2Andrew H. Nguyen, DO3Ain Shajihan, MD4Olayinka J. Agboola, MD, MPH5Sharmaine McCoy, DNP, NP6Lily N. Dastmalchi, DO7Antonio F. Saad, MD, MBA8Scott A. Sullivan, MD9Yaa Adoma Kwapong, MD, MPH10Roxanne Mirabal-Beltran, PhD, RN11Faith E. Metlock, PhD, RN12Garima Sharma, MD13University of Virginia School of Medicine, Charlottesville, Virginia, USAJohns Hopkins University School of Nursing, Baltimore, Maryland, USADivision of Cardiology, Inova Schar Heart and Vascular, Falls Church, Virginia, USADivision of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USADivision of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USADivision of Cardiology, Inova Schar Heart and Vascular, Falls Church, Virginia, USADivision of Cardiology, Inova Schar Heart and Vascular, Falls Church, Virginia, USADivision of Cardiology, Inova Schar Heart and Vascular, Falls Church, Virginia, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USADivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USAJohns Hopkins University School of Medicine, Baltimore, Maryland, USAGeorgetown University School of Nursing, Washington DC, USAJohns Hopkins University School of Nursing, Baltimore, Maryland, USADivision of Cardiology, Inova Schar Heart and Vascular, Falls Church, Virginia, USA; Address for correspondence: Dr Garima Sharma, Inova Schar Heart and Vascular, 8081 Innovation Park Dr Suite 700, Fairfax, Virginia 22031, USA.Background: Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease, highlighting the importance of thorough cardiovascular screening in individuals with prior HDP. Objectives: This retrospective cohort study evaluated rates of cardiovascular screening studies (lipid panel, lipoprotein(a), apolipoprotein B, hemoglobin A1c) ordered by cardiology in the first year postpartum before and after establishment of a postpartum cardiovascular care pathway within the Inova Health System. Methods: The study population included postpartum adults with recent pregnancies complicated by HDP seen by designated clinicians after care pathway establishment (7/1/23-3/31/24) in the cardio-obstetrics cohort (n = 113) or by cardiology before care pathway establishment (6/1/20-6/30/23) in the historical cohort (n = 179). Sociodemographic and clinical characteristics and rates of screening ordered were evaluated between cohorts. Results: There were no significant differences between cohorts in age, race/ethnicity, parity, prior history of HDP, or rates of pre-eclampsia. The mean age across both cohorts was 33 years. The cardio-obstetrics cohort had significantly higher rates of screening ordered compared to the historical cohort: lipid panel: 85.0% vs 33.0%, lipoprotein(a): 62.8% vs 6.2%, apolipoprotein B: 31.0% vs 1.1%, and hemoglobin A1c: 76.1% vs 18.4% (all P < 0.001). Evaluation of prepregnancy and postpregnancy cardiometabolic health parameters and electronic medical record-based social determinants of health and psychological health screening demonstrated elevated rates of risk factors across both cohorts. Conclusions: Implementation of a postpartum cardiovascular care pathway is feasible and is associated with significantly increased rates of cardiometabolic risk factor screening ordered in the first year postpartum.http://www.sciencedirect.com/science/article/pii/S2772963X25005137cardiovascular healthhypertensive disorders of pregnancypostpartum clinics |
| spellingShingle | Madelyn Hurwitz, BA Asma Rayani, MBBS, ScM Jared A. Spitz, MD Andrew H. Nguyen, DO Ain Shajihan, MD Olayinka J. Agboola, MD, MPH Sharmaine McCoy, DNP, NP Lily N. Dastmalchi, DO Antonio F. Saad, MD, MBA Scott A. Sullivan, MD Yaa Adoma Kwapong, MD, MPH Roxanne Mirabal-Beltran, PhD, RN Faith E. Metlock, PhD, RN Garima Sharma, MD Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy JACC: Advances cardiovascular health hypertensive disorders of pregnancy postpartum clinics |
| title | Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy |
| title_full | Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy |
| title_fullStr | Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy |
| title_full_unstemmed | Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy |
| title_short | Cardiovascular Screening Rates With Establishment of Postpartum Cardiovascular Care Pathway for Hypertensive Disorders of Pregnancy |
| title_sort | cardiovascular screening rates with establishment of postpartum cardiovascular care pathway for hypertensive disorders of pregnancy |
| topic | cardiovascular health hypertensive disorders of pregnancy postpartum clinics |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25005137 |
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